Uittenbroek R J, Spoorenberg S L W, Brans R, Middel B, Kremer B P H, Reijneveld S A, Wynia K
Afdeling Gezondheidswetenschappen, Universitair Medisch Centrum Groningen, Rijksuniversiteit Groningen, Groningen, The Netherlands,
Tijdschr Gerontol Geriatr. 2014 Apr;45(2):92-104. doi: 10.1007/s12439-014-0062-8.
Ongoing growth in health care expenditures and changing patterns in the demand for health care challenge societies worldwide. The Chronic Care Model (CCM), combined with classification for care needs based on Kaiser Permanente (KP) Triangle, may offer a suitable framework for change. The aim of the present study is to investigate the effectiveness of Embrace, a population-based model for integrated elderly care, regarding patient outcomes, service use, costs, and quality of care.
The CCM and the KP Triangle were translated to the Dutch setting and adapted to the full elderly population living in the community. A randomized controlled trial with balanced allocation was designed to test the effectiveness of Embrace. Eligible elderly persons are 75 years and older and enrolled with one of the participating general practitioner practices. Based on scores on the INTERMED-Elderly Self-Assessment and Groningen Frailty Indicator, participants will be stratified into one of three strata: (A) robust; (B) frail; and (C) complex care needs. Next, participants will be randomized per stratum to Embrace or care as usual. Embrace encompasses an Elderly Care Team per general practitioner practice, an Electronic Elderly Record System, decision support instruments, and a self-management support and prevention program - combined with care and support intensity levels increasing from stratum A to stratum C. Primary outcome variables are patient outcomes, service use, costs, and quality of care. Data will be collected at baseline, twelve months after starting date, and during the intervention period.
This study could provide evidence for the effectiveness of Embrace.
医疗保健支出的持续增长以及医疗保健需求模式的变化给全球社会带来了挑战。慢性护理模式（CCM）与基于凯撒医疗集团（KP）三角的护理需求分类相结合，可能为变革提供一个合适的框架。本研究的目的是调查“拥抱”（Embrace）这一基于人群的综合老年护理模式在患者结局、服务使用、成本和护理质量方面的有效性。
将CCM和KP三角转换至荷兰的情况，并适用于居住在社区的全体老年人群体。设计了一项采用均衡分配的随机对照试验来测试“拥抱”模式的有效性。符合条件的老年人年龄在75岁及以上，并在参与的全科医生诊所之一登记。根据中级老年自我评估和格罗宁根衰弱指标的得分，参与者将被分层为以下三个层次之一：（A）健康；（B）虚弱；（C）复杂护理需求。接下来，每个层次的参与者将被随机分配到“拥抱”模式组或常规护理组。“拥抱”模式包括每个全科医生诊所配备一个老年护理团队、一个电子老年记录系统、决策支持工具以及一个自我管理支持和预防计划——同时护理和支持强度水平从A层到C层逐渐增加。主要结局变量是患者结局、服务使用、成本和护理质量。数据将在基线、开始日期后的十二个月以及干预期间收集。
本研究可为“拥抱”模式的有效性提供证据。
